Marcia Erazo B

Tabaquismo y enfermedad pulmonar obstructiva crónica: determinación de fracciones atribuibles

Background: Smoking is the main risk factor for Chronic Obstructive Pulmonary Disease (COPD), an important cause of morbidity and mortality. Aim: To estimate smoking attributable risk and population attributable risk in COPD patients attended in Public Health Services of Santiago. Materials and methods: A case control study matched by sex and age was carried out. Crude and adjusted attributable risks as well as population attributable risk were estimated, controlled by potential confounders and by interaction variables. Results: Mean ages for cases and controls were 68 and 67 years respectively. When compared to the control group, COPD patients had a higher smoking prevalence (at least 100 cigarettes in their life span: 89.7% vs 60.3%; p <0.01). Among COPD patients, heavy smokers proportion was 4 times higher than in controls, they smoked for more years (43 vs 31; p <0.01) and more cigarettes per day (18 vs 5; p <0.01). Adjusted attributable risk was 87% (95% Confidence Interval (CI): 63.7-94.8). If a patient smoked at least 100 cigarettes in his/her life span and this risk was 92.7% (CI: 82.4-96.9) for heavy smokers. Projecting this index to Santiago inhabitants, about 87,000 individuals older than 40 years would be suffering COPD due to smoking. Conclusions: This article confirms the strong association between smoking and COPD. Attributable risks are high and significant, even when they are adjusted by confounding variables. Women had a higher risk than men, at lower levels of tobacco consumption

Comparación del estado nutricional entre escolares indígenas y no indígenas

Background: The few studies in Chile assessing the nutritional status of indigenous children show a high prevalence of stunting, excess weight and feeding problems. Aim: to compare anthropometric indices in children from indigenous and non indigenous ancestry. Subjects and methods: school children aged 6 to 8 years old, living in locations with three clear cut levels of social vulnerability were studied. Children were considered indigenous if their last names, as well as those of their parents were of Mapuche origin. Non indigenous were those whose last names were of Spanish origin. Results: four hundred and fifty indigenous and 684 non indigenous children were studied. Indigenous children from high vulnerability communities were approximately 0.5 z score shorter than those of non indigenous origin. Heights of indigenous and non indigenous children were similar in communities with intermediate and low social vulnerability. The proportion of the lower segment followed the same trend. Weight/height ratios were higher among indigenous children in the three vulnerability levels. Among indigenous children coming from areas of low vulnerability arm circumference was 1 cm broader than that of their non indigenous counterparts. Conclusions: stunting is prevalent among school children from areas of high socioeconomic vulnerability, mainly rural, and independent from ethnicity. Among indigenous school children overweight and a broader arm circumference are frequent. These results urgently call for located and specific nutrition interventions

Etnia mapuche y condiciones socioeconómicas en la estatura del adulto

Background: Studies in Chilean adults of low socioeconomic level suggest that their low height is likely to be due to their indigenous background. However this group also has been marginalized from socioeconomic development. Aim: To determine the influence of Mapuche ethnic origin and socioeconomic factors on the height of adults. Subjects and methods: In a cross sectional design, the height of 1,293 adults (528 males and 765 females) of Mapuche and non Mapuche origin were studied in the Araucania Region (Southern Chile) and in the Metropolitan Region (Central Chile). Subjects with Mapuche surnames were considered as pertaining to this ethnic community and those with Spanish surnames were considered as non Mapuche. Linear regression models were done, stratifying by sex, considering ethnic origin, to live in counties of different social vulnerability, and the level of family poverty. Results: Among males, the mean height was 166.6±7.3 cm and among females, the figure was 153.6±5.9 cm. Mapuche subjects were significantly shorter: ‐3.2 cm (95% Confidence Interval (CI) ‐4.0 to ‐2.3) among females and ‐4.8 cm (CI ‐6.0 to ‐3.6) among males (non adjusted models). This deficit increased to ‐4.5 and ‐7.6 cm among females and males, respectively when they lived in poverty and in areas with highest social vulnerability. These differences decreased significantly if Mapuche subjects lived in communities with low social vulnerability and less poverty (‐0.59 and ‐1.14 cm among females and males respectively). Conclusions: The studied population had low height, being lower in Mapuche subjects. The differences decreased among subjects living in counties of less vulnerability and less family poverty (Rev Med Chile 2005; 133: 461-8).

ANÁLISIS DE COMPONENTES PRINCIPALES APLICADO A VARIABLES RESPECTO A LA MUJER GESTANTE EN LA REGIÓN DE LAS AMÉRICAS

Objetivo: Obtener indices comparativos entre paises, respecto a la real situacion de la mujer gestante _recursos utilizados y resultados obtenidos_ en la Region de las Americas. Material y Metodos: Se recopila informacion oficial de los paises de la Region de las Americas, publicada por OMS y OPS, correspondiente a variables relacionadas con la mujer embarazada y los recursos potenciales utilizados en su atencion, ademas de los resultados obtenidos en dicha atencion. Se estudiaron 9 variables: tasa global de fecundidad, tasa de natalidad, razon de mortalidad materna, prevalencia de uso de anticonceptivos, proporcion de poblacion gestante atendida por personal capacitado durante el embarazo y partos atendidos por personal capacitado, gasto nacional en salud per capita por ano y como proporcion del PIB y gasto publico en salud como proporcion del gasto nacional en salud. Aplicamos componentes principales a partir de la matriz de correlacion R. Resultados: Se seleccionaron las dos primeras componentes principales, con un porcentaje acumulado de variabilidad explicada de 67,31%. Conclusiones: La primera componente tiene relacion con la prevalencia de uso de anticonceptivos y la proporcion de poblacion gestante cuyo parto es atendido por personal capacitado. Existe una relacion inversa de la primera componente con la tasa global de fecundidad, la tasa de natalidad y la razon de mortalidad materna. Orientaria esta primera componente a los resultados positivos que ofrecen estrategias adecuadas de servicios que privilegien la paternidad responsable. La segunda componente principal se relaciona con el gasto nacional en salud como proporcion del PIB y en forma inversa con el gasto publico en salud por ano como proporcion del gasto nacional en salud

Indicadores de gestión de servicios de salud públicos y asignación de recursos desde el Ministerio de Salud de Chile

Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadisticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificacion y Cooperacion (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05%. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined (Rev Med Chile 2004; 132: 1532-42). (Key Words: Health care facilities, manpower and services; Health services; Public health)

Tabaquismo activo y cancer pulmonar: Determinación de fracciones atribuibles por sexo

Mean age for cases was 63 years forwomen and 67 years for men. Lung cancer patients had a higher smoking prevalence thancontrols (64.5% and 39.7% respectively among women; 95.8 and 67.1 respectively among menp <0.01). Heavy smoker proportion was 4 times higher among patients that smoked 5 to 10years more (women and men respectively, p <0.01) and 3 times more cigarettes per day (p<0.01). Attributable risk for women was 64.4% and 90.4% for men. Population attributablefraction was 41.9% and 86.3% for women and men, respectively. Projecting these estimates tothe Chilean population, approximately 1975 new cases per year of lung cancer caused bysmoking will be diagnosed.

IMPACTO ECONÓMICO DE LA PREMATUREZ Y LAS MALFORMACIONES CONGÉNITAS SOBRE EL COSTO DE LA ATENCIÓN NEONATAL

RESUMENObjetivos: Calcular los costos de la atencion neonatal de recien nacidos prematuros y en portadores demalformaciones congenitas mayores compatibles con la vida. Pacientes y Metodo: Estudio retrospectivoefectuado en el Departamento de Ginecologia y Obstetricia del Hospital Clinico de la Universidad de Chile,en 82 recien nacidos menores de 34 semanas de gestacion y en 14 con malformaciones congenitasmayores, de mas de 37 semanas de gestacion, compatibles con la vida, atendidos entre enero y diciembrede 2004. Resultados evaluados son los costos de la atencion neonatal subdivididos en componentes.Resultados: El costo promedio de la atencion neonatal en recien nacidos menores de 34 semanas fue iguala

CREACIÓN DE ÍNDICES DE GESTIÓN DE MATERNIDADES MEDIANTE EL ANÁLISIS DE COMPONENTES PRINCIPALES

2.519.508, en menores de 32 semanas igual a

INDICADORES DE CALIDAD DE ASISTENCIA EN OBSTETRICIA

3.766.999, en menores de 1500 gramos igual a

Déficit de crecimiento y rendimiento escolar

12.017.650 y en portadores de malformaciones congenitas mayores compatibles con la vida de